Chapter 56: Drug Therapy for Psychotic Disorders Supplement

The nurse is preparing to give prescribed haloperidol to an acutely dehydrated client. After administration, the nurse should prioritize what nursing assessment? visual acuity blood pressure core body temperature deep tendon reflexes

blood pressure Explanation: Haloperidol can cause hypotension in clients who are volume depleted or receiving antihypertensive drugs. The client is unlikely to develop hyperthermia, diminished reflexes, or visual dysfunctions.

What client is being treated with a typical antipsychotic? An agitated client who was given haloperidol during acute psychosis A client with schizophrenia who received paliperidone 6 mg PO daily A client whose thought disorder requires clozapine 25 mg PO b.i.d. A client who recently began taking ziprasidone

An agitated client who was given haloperidol during acute psychosis Explanation: Haloperidol is a typical antipsychotic. Ziprasidone, clozapine, and paliperidone are atypical antipsychotics.

Assessment findings for a patient with neuroleptic malignant syndrome (NMS) include A.bradycardia. B.hypothermia. C.muscle weakness. D.rhabdomyolysis.

ANS: D NMS symptoms include muscle rigidity, sudden high fever, altered mental status, blood pressure fluctuations, tachycardia, dysrhythmias, seizures, rhabdomyolysis, acute renal failure, respiratory failure, and coma.

When assessing a client with schizophrenia, the nurse observes positive and negative symptoms. Which would the nurse document as a positive symptom? Select all that apply. Agitation Delusions Flat affect Alogia Avolition

Agitation Delusions Positive symptoms of schizophrenia include agitation, delusions, and hallucinations. Flat affect, alogia, and avolition are considered negative symptoms.

A male client taking an antipsychotic medication calls the psychiatric clinic and tells the nurse he is stopping his medication. He states that he has taken it for a week and it doesn't work. What is the nurse's best response? "That's strange, most clients see a change after a dose or two." "Antipsychotic medications take 6 to 10 weeks to demonstrate an effect on the disorder." "Go ahead and stop the medication and I'll tell the health care provider about your decision." "Antipsychotic medications take two to three weeks to demonstrate an effect on the disorder."

"Antipsychotic medications take 6 to 10 weeks to demonstrate an effect on the disorder." Explanation: A client would not normally see an effect of the antipsychotic for six to 10 weeks. This should be explained to the client. No effect is expected after one to two doses. Telling the client to stop the medication without educating him about normal response time is incorrect. Two to three weeks is not long enough to demonstrate an effect.

A nurse is required to administer an antipsychotic agent parenterally. After administering the drug, the nurse would ensure that the client remains lying down for which time frame? 15 minutes 30 minutes 45 minutes 60 minutes

30 minutes Explanation: After administering an antipsychotic agent parenterally, the nurse would ensure that the client remains lying down for about 30 minutes due to the potential for orthostatic hypotension and to prevent potential injuries related to a fall.

A patient has been diagnosed with neuroleptic malignant syndrome. The nurse anticipates administration of which medication to treat this patient? A.Dantrolene B.Tetrabenazine C.Propranolol D.Lorazepam

ANS: A Treatment of NMS involves immediate withdrawal of antipsychotics, adequate hydration, hypothermic blankets, and administration of antipyretics, benzodiazepines, and muscle relaxants such as dantrolene (Dantrium). Tetrabenazine (Xenazine), used to improve symptoms of Huntington's disease, seems to be effective in treating tardive dyskinesia. Propanolol (Inderal) has been found to be effective in the treatment of akathisia. Acute dystonia may be treated with lorazepam (Ativan).

A patient on risperidone may be at increased risk for injury due to A.increased potential for aspiration due to sedation. B.increased risk for falls due to orthostatic hypotension. C.increased risk for infection due to neutropenia. D.increased risk for suicide due to changes in thought processes.

ANS: B Orthostatic hypotension is the most common adverse reaction seen in patients treated with risperidone (Risperdal).

A young woman is being treated for psychosis with fluphenazine. Which sign would indicate the need to add an anticholinergic to the patient's medication regimen? A.A decrease in pulse and respiratory rate B.Facial grimacing and tongue spasms C.An increase in hallucinations D.A decrease in the patient's level of orientation

ANS: B Pseudoparkinsonism, which resembles symptoms of Parkinson's disease, is a major side effect of typical antipsychotic drugs such as fluphenazine (Prolixin). Anticholinergic medications may be used to control this side effect.

Which statement by a patient indicates that more teaching on phenothiazine therapy for the treatment of psychosis is needed? A."It might take 6 weeks or more for the drug to take effect." B."I will get up slowly from a seated position." C."When I start to feel better, I will cut the dose of my medication in half." D."I will avoid exposure to direct sunlight."

ANS: C The drug should be taken exactly as ordered. Antipsychotics do not cure the mental illness but do alleviate symptoms. Compliance with drug regimen is extremely important.

Parenteral haloperidol has been ordered for a patient who is experiencing an acute psychotic episode. The nurse should recognize what primary goal of treatment? A) Increased insight into delusional thinking B) Increased sophistication of thinking C) Decreased agitation and combativeness D) Decreased CNS stimulation

Ans: C Feedback: When haloperidol is given for acute psychotic episodes, the nurse observes for sedation, decreased agitation, combativeness, and psychomotor activity. Insight, clarity of thinking, and decreased CNS stimulation are not short-term priorities during an acute psychotic episode.

A nurse is assessing a client who has been receiving an antipsychotic. The nurse concludes this client will have a decreased potential of developing extrapyramidal side effects due to receiving which additional drug? Select all that apply. Lithium Aripiprazole Chlorpromazine Prochlorperazine Clozapine

Aripiprazole Clozapine Atypical or second-generation antipsychotics (SGAs) are referred to atypical because the typical EP side effects are lessened. Aripiprazole and clozapine are classified as atypical antipsychotics. Lithium is an antidepressant mood stabilizer which has the adverse effects of headache, drowsiness, tremors, nausea, and polyuria. Chlorpromazine and prochlorperazine are conventional or first-generation antipsychotics (FGAs) which have EPS and TD as adverse effects.

A client comes to the emergency department and tells the nurse, "I've been hiccoughing constantly for the past 6 or 7 hours and nothing I do to stop them seems to work." The nurse would expect the primary health care provider to prescribe which medication? Prochlorperazine Chlorpromazine Fluphenazine Olanzapine

Chlorpromazine Explanation: Chlorpromazine may be used to treat uncontrolled hiccoughs. Prochlorperazine may be used as an antiemetic. Fluphenazine and olanzapine are not indicated for uncontrolled hiccoughs.

A mother is concerned about recent behaviors by her young-adult son, and asks the nurse about what behaviors characterize schizophrenia. The nurse knows that the characteristics of schizophrenia include what actions? (Select all that apply.) Disordered thinking Abnormal behavior Impaired socialization Repetitive actions Sexual promiscuity

Disordered thinking Abnormal behavior Impaired socialization Schizophrenia is characterized by disordered thinking, abnormal behavior, and impaired socialization. Sexual promiscuity and repetitive actions are not common characteristics of schizophrenia.

A client is started on aripiprazole and the nurse notices the client is experiencing dry mouth and nasal congestion. What intervention does the nurse teach the client to minimize the side effects of the medication? Drinking frequent sips of water Consuming the medication with food Discussing feelings of nervousness or restlessness Calling the prescriber for an anticholinergic medication

Drinking frequent sips of water Explanation: Dry mouth and nasal congestion are generalized system reactions of aripiprazole. To relieve dry mouth, take frequent sips of water, suck on hard candy, or chew gum. Consuming more food will not address the dry mouth issue. The client is not feeling nervousness or restlessness. Calling the prescriber for an anticholinergic medication will exacerbate the dry mouth and nasal congestion issues.

The nurse is conducting an ongoing assessment of a client who is prescribed loxapine. Which finding is most likely attributable to this medication? Hypertension Skin dryness Dry mouth Bradycardia

Dry mouth Explanation: Antipsychotics such as loxapine may cause adverse effects of dry mouth, drowsiness, akathisia, EPS, headache, and orthostatic hypotension. Antipsychotics are contraindicated in clients with severe hypertension. Bradycardia can be a sign of hypertensive crisis, which is an adverse effect of MAOIs. Skin dryness is a recognized adverse effect to clofazimine, a drug used to treat M. leprae.

Extrapyramidal symptoms include all of the following except: Dystonia. Tardive dyskinesia. Dystocia. Akathisia.

Dystocia. Explanation: Dystocia is an abnormal or difficult childbirth or labor. All the other options are components of EPS.

A 28-year-old woman has been diagnosed with schizophrenia. The health care provider has prescribed a typical antipsychotic, haloperidol. Which will the nurse include in the teaching related to the most common adverse effects? Neuroleptic malignant syndrome Agranulocytosis Extrapyramidal symptoms Gastrointestinal problems

Extrapyramidal symptoms Explanation: Extrapyramidal symptoms (EPS) are the most common adverse effects of haloperidol. The cause of these symptoms is the relative lack of dopamine stimulation (i.e., excess dopamine blockade) and relative excess of cholinergic stimulation. Neuroleptic malignant syndrome and agranulocytosis are relatively rare, although potentially fatal adverse effects. Gastrointestinal problems are considered uncommon adverse effects of the drug.

The nurse should be able to distinguish signs of extrapyramidal syndrome (EPS) in clients taking antipsychotics so they can be quickly reported to the client's health care provider. What are signs of EPS? Select all that apply: Fine tremor Hypotension Akathisia Anhedonia Dystonia

Fine tremor Akathisia Dystonia

Parents bring a 15-year-old male into the clinic. The parents tell the nurse that there is a family history of schizophrenia and they fear their son has developed the disease. What is an appropriate question to ask the parents? Which of your family members did not have schizophrenia? What symptoms should he have? What health care providers have you taken your son to? How long has your son been exhibiting symptoms?

How long has your son been exhibiting symptoms? Explanation: Characteristics of schizophrenia include hallucinations, paranoia, delusions, speech abnormalities, and affective problems. This disorder, which seems to have a very strong genetic association, may reflect a fundamental biochemical abnormality.

The nurse is caring for a client diagnosed with HIV. The nurse should question a new order for clozapine due to which currently prescribed drug? Select all that apply. Immunologics Anticholinergics Opioids Anticoagulants

Immunologics Explanation: Immunological agents are used to treat HIV. It is contraindicated to give a client with bone marrow suppression clozapine. The concomitant use of clozapine and immunological drugs can increase the severity of bone marrow suppression. The use of anticholinergics in combination with antipsychotics can increase the risk of tardive dyskinesia and psychotic symptoms. Opioids and anticoagulants are not associated with interactions involving antipsychotic drugs.

The nurse knows that which of the following is true about tardive dyskinesia? It is reversible. It is irreversible. It consists of prolonged muscle contractions. It causes hallucinations.

It is irreversible. Explanation: Tardive dyskinesia is irreversible. It does not consist of prolonged muscle contractions; instead, it is the rhythmic involuntary movements of the tongue, face, mouth, or jaw. Tardive dyskinesia does not cause hallucinations.

Which of the following atypical antipsychotics are associated with weight gain? Select all that apply: Olanzapine (Zyprexa) Risperidone (Risperdal) Ziprasidone (Geodon) Quetiapine (Seroquel) Clozapine (Clozaril)

Olanzapine (Zyprexa) Risperidone (Risperdal) Olanzapine (Zyprexa) and risperidone (Risperdal) are atypical antipsychotics that are associated with weight gain.

The nurse is teaching a client and caregiver about the antipsychotic medication which has been prescribed. The nurse determines the teaching is successful when they correctly choose which reaction should be reported immediately to the health care provider? Orthostatic hypotension Dry mouth Rigidity Drowsiness

Rigidity Explanation: The nurse should immediately report to the primary health care provider the following: rigidity, restlessness, inability to sit still, muscle spasms, mask-like expression, tremors, drooling, or involuntary rhythmic movements of the face, mouth, or extremities. Dry mouth, episodes of orthostatic hypotension, and drowsiness are reactions that are considered normal during drug therapy and need not be reported unless severe.

A nursing instructor is teaching a class on the various antipsychotic drugs. The instructor determines the class is successful when the students correctly choose which receptors as the target of antipsychotic medications? Select all that apply. Serotonin Dopamine Gamma-aminobutyric acid Norepinephrine Monoamine oxidase

Serotonin Dopamine Atypical, or second generation, antipsychotic (SGAs) drugs are thought to act on serotonin and dopamine receptors in the brain. The conventional, or first-generation, antipsychotics (FGAs) work to diminish the positive symptoms by blocking dopamine transmission. Muscarinic receptors are neurologic receptors that stimulate smooth muscle in the parasympathetic branch of the autonomic nervous system. The nicotinic receptors are neurologic receptors that stimulate skeletal muscles in the parasympathetic branch of the autonomic nervous system.

After teaching a group of nursing students about adverse reactions associated with antipsychotic drugs, the instructor determines that the teaching was successful when the students identify which as an irreversible adverse reaction associated with the use of antipsychotics? Tardive dyskinesia Extrapyramidal syndrome Neuroleptic malignant syndrome (NMS) Serotonin syndrome

Tardive dyskinesia Explanation: Tardive dyskinesia is a syndrome consisting of irreversible, involuntary dyskinetic movements characterized by rhythmic, involuntary movements of the tongue, face, mouth, or jaw and sometimes the extremities. The tongue may protrude, and there may be chewing movements, puckering of the mouth, and facial grimacing. Extrapyramidal syndrome is characterized by Parkinson-like symptoms, akathisia, and dystonia. NMS is a rare reaction characterized by a combination of extrapyramidal effects, hyperthermia, and autonomic disturbance.

Olanzapine has been prescribed for a new client. What should the nurse assess or confirm before administration of olanzapine? blood glucose urine specific gravity serum cholesterol hemoglobin and hematocrit

blood glucose Explanation: Olanzapine has been associated with weight gain, hyperglycemia, and initiation or aggravation of diabetes mellitus. The other options are not necessary for clients taking olanzapine unless a secondary diagnosis indicates a need.

A client with schizophrenia is prescribed clozapine. For which information in the medical record will the nurse question giving this medication to the client? history of seizure disorder vegetarian eating plan treatment for rheumatoid arthritis remote work in customer service

history of seizure disorder Explanation: Clozapine is contraindicated for use in a client with a history of seizure disorders. The medication is not contraindicated for any specific eating plan. Treatment for rheumatoid arthritis is not a contraindication for this medication. The type of employment is not identified as a contraindication for this medication.

The nurse suspects that a client receiving olanzapine is developing type 2 diabetes. Which finding would help support the nurse's suspicion? Select all that apply. increased thirst weight gain increased urination fever sore throat

increased thirst weight gain increased urination The nurse would suspect development of type 2 diabetes based on assessment of increased thirst and urination and weight gain. Fever and sore throat would suggest an infection, possibly due to agranulocytosis from clozapine therapy.

Antipsychotic drugs are contraindicated in clients with: liver damage, coronary artery disease, severe hypertension, bone marrow depression, or cerebrovascular disease. kidney damage, chronic obstructive lung disease, mild hypotension, and chronic bone pain. nausea, severe hypotension, or intractable hiccups. peptic ulcer disease, mild hypertension, chronic joint pain, and kidney failure.

liver damage, coronary artery disease, severe hypertension, bone marrow depression, or cerebrovascular disease. Explanation: Because of their wide-ranging adverse effects, antipsychotic drugs may cause or aggravate a number of conditions. They are contraindicated in clients with liver damage, coronary artery disease, cerebrovascular disease, parkinsonism, bone marrow depression, severe hypotension or hypertension, coma, or severely depressed states. They should be used cautiously in people with seizure disorders, diabetes mellitus, glaucoma, prostatic hypertrophy, peptic ulcer disease, and chronic respiratory disorders.

A client with an acute onset of disorganized thinking and hallucinations is prescribed an intramuscular dose of chlorpromazine. How soon after administration can the nurse assess for therapeutic effect? in 4-6 hours immediately within 20 minutes after 30 minutes

within 20 minutes Explanation: Chlorpromazine is well absorbed and distributed to most body tissues, and it reaches high concentrations in the brain. After intramuscular administration, the onset of action is 10 to 15 minutes, with a peak at 15 to 20 minutes. An intramuscular dose of the medication has a duration of 4 to 6 hours. An oral dose of the medication has an onset of action of 30 to 60 minutes and will peak between 2 and 4 hours.

The nurse administers chlorpromazine intramuscularly to a client. The nurse would maintain the client in bed for at least how long after administering the drug? ½ hour 1 hour 2 hours 3 hours

½ hour Explanation: After administering parenteral forms of antipsychotic agents, the nurse should keep the client recumbent for approximately ½ hour to reduce the risk of orthostatic hypotension.

The parents of a child receiving a central nervous system stimulant for treatment of attention deficit disorder asks the nurse why they are stopping the drug for a time. Which statement by the nurse would be most appropriate? "He probably doesn't need the medication anymore since he is getting older." "We need to check and see if he still has symptoms that require drug therapy." "The drug should be used for a specified period of time and then switched to another." "He is prone to developing severe adverse effects if he stays on it any longer."

"We need to check and see if he still has symptoms that require drug therapy." Explanation: Periodically, the drug therapy needs to be interrupted to determine if the child experiences a recurrence of symptoms, which would indicate the need for continued treatment.

A patient in her 60s has been living with schizophrenia since she was a young woman and was treated with chlorpromazine for many years. The nurse who is meeting the patient for the first time observes that the patient continually smacks her lips and appears to be chewing. The nurse should recognize that this patient is likely experiencing what problem? A) Tardive dyskinesia B) Akathisia C) Dystonias D) Neuroleptic malignant syndrome

Ans: A Feedback: Tardive dyskinesia occurs as the result of long-term use of chlorpromazine. Patients may experience lip smacking, tongue protrusion, and facial grimaces and may have choreic movements of trunk and limbs. Akathisia is a form of restlessness, and dystonias are uncoordinated movements. Neuroleptic malignant syndrome is an acute complication.

The nurse is caring for an older client with dementia. For which reasons will the nurse question giving the client a prescribed antipsychotic medication? Select all that apply. increases the risk of mortality leads to greater cognitive decline enhances extrapyramidal adverse effects increases the risk of cerebrovascular accident, or stroke prevents neurotransmitters from interacting with the receptor sites

increases the risk of mortality leads to greater cognitive decline increases the risk of cerebrovascular accident, or stroke All antipsychotics are identified in the Beers criteria as potentially inappropriate medications in clients 65 years and older with dementia. Antipsychotics should be avoided because they increase the risk of mortality, lead to greater cognitive decline, and increase the risk of cerebrovascular accident, or stroke. Antipsychotics do not enhance extrapyramidal adverse effects. The intended action of antipsychotic medications is prevention of the neurotransmitters dopamine and serotonin from attaching to receptor sites.

A patient diagnosed with schizophrenia is being seen by the home care nurse. What is the most important aspect of patient teaching with this patient? A) Maintain the medication regimen. B) Report signs of neuralgia. C) Stop medications if weight gain occurs. D) Limit alcohol intake to two drinks per day.

Ans: A Feedback: The patient should be instructed to maintain the medication regime to control symptoms of schizophrenia. Reporting signs of neuralgia is not taught because the medication does not have this effect. The medications will cause weight gain and should not be stopped in the event that weight gain develops. The use of alcohol is strictly prohibited with antipsychotic agents.

A patient who has a diagnosis of schizophrenia is likely to have which of the following pathophysiologic effects? A) Increased dopamine B) Increased serum potassium C) Decreased numbers of glutamate receptors D) Decreased interaction with GABA

Ans: A Feedback: The patient suffering from schizophrenia has increased dopamine activity in the brain. The amount of potassium would cause other physiological symptoms, but not affect schizophrenic symptoms. The patient with schizophrenia will have widespread glutamate receptors, not decreased glutamate receptors. In addition, the glutamatergic system interacts with the dopaminergic and gamma-aminobutyric acid systems and possibly other neurotransmission systems.

A patient with schizophrenia has been taking haloperidol for several years. The care team and the patient have collaborated and chosen to transition the patient to an atypical antipsychotic in an effort to reduce adverse effects and maximize therapeutic effects. In order to reduce the patient's risk of extrapyramidal effects during this transition, the care team should do which of the following? A) Gradually taper the dose of haloperidol. B) Have a 2- to 3-week "drug holiday" between stopping the haloperidol and starting the atypical antipsychotic. C) Administer haloperidol and the atypical antipsychotic drug concurrently for 6 to 8 weeks. D) Arrange for weekly electroconvulsive therapy during the time of transition.

Ans: A Feedback: When discontinuing haloperidol, it is essential to taper the dosage to prevent extrapyramidal symptoms. If the medication is abruptly discontinued, the patient is at risk for this condition. A drug holiday would exacerbate symptoms, and ECT is not indicated. Concurrent administration of two drugs has the potential to exacerbate adverse effects.

A patient who was diagnosed with schizophrenia in 1962 was prescribed chlorpromazine (Thorazine). The patient has been taking the medication for more than 40 years. What adverse effect will the patient most likely experience? A) Hypertension B) Extrapyramidal effects C) Central nervous system agitation D) Urinary frequency

Ans: B Feedback: A patient who has taken chlorpromazine (Thorazine) on a long-term basis will be at risk for late extrapyramidal effects. Hypertension is not an adverse effect of chlorpromazine, but hypotension is an adverse effect. Central nervous system agitation is not an adverse effect of chlorpromazine, but central nervous system depression is an adverse effect. Urinary frequency is not an adverse effect of chlorpromazine, but urinary retention is an adverse effect.

A psychiatric nurse is providing care for a female patient with schizophrenia whose medication regimen includes oral chlorpromazine. When administering this medication, the nurse should do which of the following? A) Have the patient hold the drug under her tongue for at least 30 seconds. B) Administer the drug 1 to 2 hours before bedtime. C) Administer the drug on alternating days. D) Instruct the patient to avoid dairy products for 1 hour before and 2 hours after administration.

Ans: B Feedback: For oral administration of chlorpromazine, the nurse should give doses 1 to 2 hours before bedtime; peak sedation occurs in about 2 hours. The drug is not given on alternating days, and there is no need to avoid dairy products. It is unnecessary for the patient to hold the drug under her tongue.

A 22-year-old man's increasingly bizarre behavior has culminated in a diagnosis of schizophrenia. In light of current treatment modalities for schizophrenia, the nurse should anticipate that the patient is most likely to be prescribed what drug? A) Chlorpromazine (Thorazine) B) Olanzapine (Zyprexa) C) Haloperidol (Haldol) D) Prochlorperazine (Compazine)

Ans: B Feedback: The "atypical" antipsychotics, such as olanzapine, are the drugs of choice, especially for patients who are newly diagnosed with schizophrenia.

A patient is prescribed olanzapine (Zyprexa) for the treatment of schizophrenia. The patient tells the nurse he is voiding three times each night and is always thirsty. Based on the adverse effects of this medication, what should the nurse suspect the patient has developed? A) Urinary tract infection B) Diabetes mellitus C) Renal calculi D) Hyperthyroidism

Ans: B Feedback: The development of polyuria and polydipsia is indicative of diabetes mellitus. Olanzapine has been associated with weight gain, hyperglycemia, and initiation or aggravation of diabetes mellitus. Urinary tract infection is not considered an adverse effect with olanzapine. Renal calculus is not an adverse effect of olanzapine. Hyperthyroidism is not an adverse effect of olanzapine.

A patient is experiencing an episode of psychosis. He is belligerent, loud, and abusive when you enter the room. What is the best response by the nurse during future interactions? A) Respond to him in an assertive tone. B) Use a calm, soft voice. C) Delegate care to the technician. D) Place him in the quiet room.

Ans: B Feedback: The most therapeutic communication technique for this patient is to use a calm, soft voice. To respond to the patient in a loud tone will increase his agitation. Delegating care to the patient care technician can increase the patient's agitation based on the fact that the unlicensed caretaker may not possess strong therapeutic communication skills. Placing the patient in a quiet room will not affect any changes in his behavior and may increase his hallucinations.

A psychiatric nurse is discussing the advantages of atypical antipsychotics with the parents of a teenage girl who has been diagnosed with schizophrenia. When comparing these drugs with the older, typical antipsychotics, what advantage should the nurse cite? A) Lower cost B) The possibility of oral administration C) Reduced adverse effects D) Absence of black box warnings

Ans: C Feedback: Atypical antipsychotics may be more effective in relieving some symptoms than typical antipsychotics, and they usually produce milder adverse effects. A major drawback is the high cost of these drugs. All antipsychotics are available for the oral route. There are several black box warnings relating to atypical antipsychotics.

An elderly patient with a long-standing history of schizophrenia has been admitted to the hospital for treatment of hyponatremia. The nurse reviews the patient's medical chart and reads that the patient was previously treated with phenothiazine antipsychotics. What medication may this patient have been treated with? A) Aminophylline (Theophylline) B) Acetylsalicylic acid (aspirin) C) Chlorpromazine (Thorazine) D) Dantrolene sodium (Dantrium)

Ans: C Feedback: Chlorpromazine (Thorazine) is the prototype phenothiazine. Aminophylline (Theophylline) is a xanthine agent administered to increase bronchioles. Acetylsalicylic acid (aspirin) and dantrolene sodium (Dantrium) are not phenothiazines.

A child suffers from tics and verbal outbursts in the classroom and while he is awake. The patient is prescribed haloperidol (Haldol). What disease process is haloperidol (Haldol) used to treat? A) Muscular dystrophy B) Early-onset dementia C) Tourette's syndrome D) Myasthenia gravis

Ans: C Feedback: Haloperidol (Haldol) is used in treating Tourette's syndrome, which is a disorder characterized by involuntary movements and vocalizations. Muscular dystrophy is not treated with atypical antipsychotics. Alzheimer's disease is not normally treated with atypical antipsychotics. Myasthenia gravis is not treated with atypical antipsychotics.

A teenage boy has begun to exhibit the characteristic signs and symptoms of schizophrenia. During his mother's pregnancy, during what time in development could she have experienced an intrauterine insult? A) Conception B) First trimester C) Second trimester D) Third trimester

Ans: C Feedback: The neurodevelopmental model proposes that schizophrenia results when abnormal brain synapses are formed in response to an intrauterine insult during the second trimester of pregnancy, when neuronal migration is normally taking place. At conception, no implantation in the uterus has occurred. The first trimester is prior to neuronal migration. The third trimester is after neuronal migration.

A patient is admitted to the hospital for cardiac surgery and has just come up to the postsurgical unit from the recovery room. He develops unprecedented confusion and states, "I see bugs up and down the walls. They are going to get me." The nurse suspects the patient is suffering from what symptom? A) Depression B) Delusions C) Delirium D) Schizophrenia

Ans: C Feedback: The patient is suffering from delirium as a postoperative complication. Delusions are false beliefs that persist in the absence of reason or evidence. Schizophrenia is a variety of disorders and not a single symptom.

A person is seen wandering the streets and talking in an animated way to people who are not there. From what disorder do you suspect the person is suffering? A) Confusion B) Delusions C) Psychosis D) Depression

Ans: C Feedback: The patient is suffering from psychosis, which is a severe mental disorder characterized by disordered thought processes. Delusions are false beliefs that persist in the absence of reason or evidence and are also a symptom of a psychosis. Depression is a disorder and symptom that is not as severe as a psychotic disorder. Confusion is a more generic term that denotes a lack of clear thinking.

A patient has been achieving an acceptable reduction in his positive and negative signs of schizophrenia after several weeks of treatment with clozapine. The patient has asked the nurse if it is acceptable for him to have "a few drinks from time to time." How should the nurse best respond to the patient's inquiry? A) "If you notice that your symptoms are worsening when you drink, you should stop doing it." B) "That shouldn't present a problem, provided you make sure that you're safe when you do it." C) "That's okay in most cases, but it's advisable to limit it to beer and wine and to avoid spirits." D) "When you're taking clozapine, it's best to avoid drinking alcohol altogether."

Ans: D Feedback: Alcohol increases central nervous system depression in patients taking clozapine; patients should ideally abstain from drinking alcohol.

A patient is prescribed clozapine (Clozaril). The patient and family should be instructed on the adverse effects of this medication. What laboratory test is most important in the first months of the medication regime? A) Weekly liver enzymes B) Daily INR C) Monthly creatinine levels D) Regular complete blood counts

Ans: D Feedback: Clozapine (Clozaril) is associated with life-threatening decrease in white blood cells (agranulocytosis). It is essential to monitor the complete blood count due to this risk. Weekly liver enzymes are not recommended when administering clozapine. Monthly creatinine levels and INR monitoring are not recommended with clozapine therapy

A patient's medication administration record orders the IM administration of chlorpromazine. When administering this drug, the nurse should A) observe the patient while he or she self-administers the drug. B) administer the drug into the deltoid muscle with a 1 1/2-inch needle. C) have the patient massage the injection site for 1 to 2 minutes after the injection. D) have the patient lie down for 30 to 60 minutes after the injection.

Ans: D Feedback: For IM administration of chlorpromazine, the nurse should have the patient lie down for 30 to 60 minutes after the injection to prevent orthostatic hypotension. Massage is unnecessary, and the ventrogluteal site is used. Self-administration is not the norm.

A patient has been prescribed an antipsychotic agent to relieve psychotic symptoms. Which of the following goals of care is the priority? A) The patient will demonstrate independent health maintenance. B) The patient will interact therapeutically with peers. C) The patient will participate in activities of daily living. D) The patient will remain safe.

Ans: D Feedback: Safety is a priority over other goals. Goals such as participation in ADLs, health maintenance, and participation in relationships are valid, but safety is a priority.

A caregiver of a client with nausea and vomiting is surprised when the nurse administers an antipsychotic to the client. The nurse explains this is a secondary use for the medication. Which medication has the nurse given the client? Select all that apply. Lithium Aripiprazole Chlorpromazine Prochlorperazine Clozapine

Chlorpromazine Prochlorperazine Chlorpromazine and prochlorperazine are antipsychotic medications that have antiemetic effects. Lithium, aripiprazole, and clozapine do not have secondary uses. Lithium is an antidepressant which acts as a mood stabilizer. During manic episodes of bipolar disorder, aripiprazole is used in clients with schizophrenia during the manic phase of bipolar disorder. Clozapine is used when a client is severely ill with schizophrenia and nonresponsive to other drugs.